Using Platforms to Transform recruitment across the
English & Welsh National Health Service
The Previous situation
Background to the NHS
Since its launch in 1948, the UK National Health Service, or NHS, has grown to become
the world’s largest publicly funded health service. It is also one of the most efficient,
most egalitarian and most comprehensive. The NHS was born out of a long-held ideal
that good healthcare should be available to all, regardless of wealth, a principle that
remains at its core. With the exception of some charges, such as prescriptions and
optical and dental services, the NHS remains free at the point of use for anyone who is
resident in the UK. That is currently more than 63.2m people. It covers everything from
antenatal screening and routine treatments for long-term conditions, to transplants,
emergency treatment, and end-of-life care. The NHS deals with over 1 million patients
every 36 hours.
Scale of NHS’ recruitment operation
The NHS employs more than 1.7m people. Of those, just under half are clinically
qualified, including, 39,780 general practitioners (GPs), 370,327 nurses, 18,687
ambulance staff and 105,711 hospital and community health service (HCHS) medical
and dental staff.
Globally, only the Chinese People’s Liberation Army, the Wal-Mart supermarket chain
and the Indian Railways directly employ more people. The NHS in England is the biggest
part of the system by far, catering to a population of 53m and employing more than
1.35m people. The NHS in Scotland, Wales and Northern Ireland employs 153,427;
84,817 and 78,000 people respectively. 1
The need for change: a gradual realisation
With a workforce the size of the NHS, the Department of Health, ultimately responsible
for governing the NHS in England and Wales, had begun to realise that its traditional
ways of recruiting, which had evolved slowly over decades since the formation of the
NHS in 1948, were increasingly inadequate. With the NHS’ highly federal structure of
over 500 NHS organisations, there were now over 10,000 people involved just in
recruitment – and these people were only responsible for recruiting into their own local
areas. The result was an enormous duplication of people and processes, and enormous
cost, throughout the health service. Furthermore, the resulting service suffered:
because of all this regional separation, and the resulting limited communication
between the 500 NHS organisations, both employers and applicants had very limited
visibility of demand and supply nationwide; advertising was often limited to paper1Background
taken from http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx
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based publications such as Nursing Times. Thus a surgeon, nurse, or hospital cleaner
looing for a job in Cambridgeshire might be unaware of urgent demand for their services
in neighbouring Hertfordshire! And of course patients often suffered as a result of this
unavailability as well.
Time for Change
Department of Health issues a requirement
By 2002, there was a growing realisation that this situation was unsustainable. The
Department of Health responded by doing something that government departments
have traditionally done in these situations: it decided to build some technology to
address the problem. Accordingly the government went out to tender for a company to
build it a ‘national e-recruitment system’ that would then provide a central location
where it could advertise and process vacancies. The advertisement for tenders was
placed in the press, and several of the leading technology suppliers in the UK began to
discuss if, and how, they might bid for this work.
Over at Methods Consulting (now Methods Group2), Kit Jones, director of Methods’
public sector practice, was pondering the same problem. The issue for Methods was
that the company was a) not a technology-builder, or ‘systems integrator’ (SI); and b)
neither was it one of the usual, established organisations to whom the government
typically went with this sort of requirement. In fact, Methods was a 10-year old SME
with no previous experience of any contract of this size at all. That said, they had a
couple of things going for them: they had a long and well-established background in
public sector and healthcare organisations; and, as an SME that was traditionally
excluded from these sorts of large system-build procurements, they had nothing to lose.
Kit needed to think out of the box.
Responding to the NHS: Methods’ strategy
As he pondered, something nagged away at the edge of his mind. Like other people, he’d
been becoming increasingly aware of the way in which internet-based technologies had
been enabling the creation of new products and services that worked in ways that had
not been possible before. These products and services (since called digital platforms –
see inset box) seemed to have been turning traditional, vertically-integrated
organisations on their heads, by offering easy access to standardised, commodity
services as a cheap alternative to doing things in-house. He realised that government
had been very slow to embrace this new sort of model – but wondered if there might be
the possibility of a disruptive play here for Methods. He picked up the phone to Dave
Turnbull, the Bid Team manager.
What are digital platforms?
Digital platforms are tech-enabled B2B and B2C business models that provide lots of
people with the ability to access and consume standard products and services cheaply,
like commodities. Well-known examples include eBay (standardised
marketplace/fulfilment), iOS and Android (standard environment for building apps),
cloud computing providers (standard hosting environment), and some transaction
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www.methods.co.uk
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processing systems such as Bankers’ Automated Clearing Services (BACS), which
processes electronic financial transactions in the UK. What distinguishes these as
platforms is that their ease of access stimulates traffic on the platform, which creates
potential demand for services using the platform.
This in turn encourages ‘ecosystems’ of service providers to innovate and invest in new
services that make use of the platform. So the ‘digital’ bit really refers to the way in
which web-based technologies allow lots of people to connect and access these
services; the ‘platform’ bit refers to the business models that are encouraged by all this
connectivity. it’s no accident that we use the word ‘platform’, either: these
business models are horizontal in nature, providing services across many
organisations that might previously have integrated these functions vertically within
traditional silos.
“What do we know about platform-based business models?”, Kit asked Dave. “Well,”
Dave responded, “we know that they perform well in industries where there’s a lot of
potential pent-up demand to consume things in standard ways – if only there was a way
to standardise this demand. For example, the reason you can go downtown and
purchase an electric appliance for a commodity price, that works as soon as you plug it
into the wall, is because we have all standardised on a 240v power supply in the UK.
Those common standards are a platform that incentivises a whole ecosystem of
suppliers to build products that all work on 240v – because they know that all of those
consumers who have all standardised on that platform represent one huge marketplace
for them.”
“So is it the 240v electricity itself that is the platform, or is it all that consolidated market
demand?”, asked Kit.
“It’s both! cried Dave. Many people tend to think of ‘platforms’ as a piece of technology.
In some cases, they are (for example, standardised car parts shared between different
vehicle manufacturers). However, in the case of open platforms that anyone can access,
such as electricity, it’s as much the lure of all those customers using the platform as it is
the thing they’ve standardised on (the common voltage)”.
“So, let’s look at this invitation to tender, then”, Kit replied. “What we do know is that
the NHS has lots and lots of organisations, all of whom are performing what should be a
relatively straightforward function in myriad different ways, none of which work
together. So, in terms of improving the process, the biggest risk for the NHS is its ability
to persuade these 10,000 HR personnel to converge on standard recruitment processes!
It’s not actually building a piece of technology that’s the issue here (there are lots of
available applications that could be used).”
“OK”, Dave ventured cautiously, “so why don’t we consider proposing a different
solution to the Department of Health than the one they’re actually asking for? Rather
than the Department building a piece of bespoke technology, which they have to
maintain, upgrade, etc, they could consume a service based on a double-sided brokerage
platform: i.e. a space where both NHS recruiters and candidates (both demand- and
supply-sides) go, and which treats each side as the customer? We could subcontract the
provision of the job board to a specialist provider of job boards – and provide a ‘service
wrap’ where we take responsibility to the Department of Health for the success of the
service – driving user takeup, etc. And rather than just charging a fixed sum for
development of a system, we could develop an innovative pricing offering that links
payment to a number of different measures of success?”
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Dave paused, because he noticed that Kit was staring at him, eyes wide open. “That’s it!,
Kit exclaimed. We could really disrupt this market, which is ripe for commoditisation –
just the sort of thing that platforms are good at! And we really have nothing to lose – no
existing market share, nothing – which makes it doubly attractive”.
Methods’ proposal
So Kit and Dave developed their bid. They proposed exactly that to the Department of
Health: a ‘wraparound’ service, provided by Methods, where Methods took
responsibility for providing the technology, but also for developing both the demandand supply-sides of the platform business model. They proposed a pricing model made
up of milestone payments for initial set-up project costs (remember they were an SME
so needed to stage the risk somewhat); set monthly service charges with a service credit
regime where the Department could claim credits against any non-performance;
efficiency saving reductions year on year, and organisation take-on charges (to enable
them to on-board each of the 500 NHS organisations). Importantly, Kit and Dave
ensured that there would be no limit on usage within organisations permitted to use the
service; and of course the service was free for applicants nationwide. This was an
important part of driving the network effects of the platform; the more traffic it could
develop, the more valuable the service would be to its various stakeholders – driving yet
more takeup of the service. Methods won the tender!
The site looked like this:
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Rollout: Managing the transformation
Choosing a proven, reuseable technology solution was only one of the elements needed
for success. Methods identified quickly that this was a new type of shared service: a
single, nationally available commodity that would be ‘consumed’ on a transactional
basis by NHS employers throughout the country – and therefore that they key risk lay
not in the delivery of the software (which was a relatively simple exercise) but in
persuading the many thousands of NHS employers to make use of it, leaving behind
their old, comforting ways of doing things.
Stakeholder management
Effective stakeholder management was essential to the successful launch and takeup of
this service, which Methods developed and implemented in the face of widespread
scepticism in terms of the negative reputation that surrounded many NHS-wide IT
projects (the NHS Programme for IT for example, a venture to join up healthcare
providers across the UK, had just wasted >£12bn!).
With this in mind, it was vital to break down various misconceptions regarding the
concept of a national e-recruitment service, on the IT front (e.g. the viability of a hitherto
untried, national-level, recruitment service) – as well as in terms of stakeholders’
concept of how recruitment is done (an example was the widespread assumption that
closing dates for vacancies were necessary; they weren’t).
Proactive marketing
Business development – persuading people across the UK to use this service –
represented the biggest challenge of all in the whole programme. This was particularly,
of course, since Methods payment, as described above, was linked to levels of takeup of
the service within the NHS. Accordingly, this became the biggest focus of all. Methods
approached the daunting task of persuading 500+ established organisations, each with
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their own legacy ways of doing things, to standardise on a national platform using the
following approach:

Involvement of ‘ambassador users’ throughout the workshopped design stage,
thus ensuring that they could return to their own communities and spread a
positive message regarding the feasibility of the service, as well as the evident
benefits that this would bring

Delivery of briefing and training sessions with each individual employer
organisation, ensuring that the benefits of the service were fully understood –
and that users were comfortable with the operational aspects of getting started
and running on the platform

Ongoing, continually updated support through national user groups, local user
groups and widely available best practice information, available to the
potentially 1 million NHS staff who might come into contact with the service.
The launch of the platform needed to be well-publicised (Methods needed to build both
sides of the platform, remember!), but also well managed so that publicity (and potential
demand) did not run out of control of the project team. Methods therefore worked
directly with the Department of Health to co-ordinate public relations campaigns to let
employers (needed to place advertisements) and the general public (needed to apply for
the vacancies) respectively aware of the service.
Methods and the Department issued several phased press releases, including ministerial
statements, informing both NHS employers and the public about the service – as well as
co-ordinating responses to questions asked in Parliament – some which were tabled by
some of the ‘old’ companies that used to handle local recruitment for the NHS – whose
business models had been disrupted forever. As takeup of the service grew on each side
of the platform, Methods was careful to follow up with carefully co-ordinate press
releases re-inforcing the benefits that had been achieved by the NHS through the use of
the service.
Results
Performance
NHS Jobs is now one of the world’s top internet recruitment sites – and the best, proven
example of ‘government as a platform’ (GaaP) in the UK. Using the above techniques,
Methods achieved a 100% take-up with over 600 NHS trusts in less than 18 months
across the whole of the NHS in England. NHS Jobs is the largest single employer
recruitment site in Europe, with in excess of 6 million unique visits each month,
equivalent to a unique visit every 2 seconds, 24 hours a day. This results in over
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275,000 job applications per month. The service provides exemplary response times
with availability in excess of 99.9%.
Savings
With the current climate of the need for public sector savings, the NHS Jobs platform has
thus far generated savings of well over £1bn from reduction in administration – all those
redundant, duplicate processes – as well as advertising costs (all those redundant
supplier business models). Of this, the Department of Health acknowledges savings of
over £280m on administration since 2003, chiefly from going paperless in relation to
the assembly of job packs and other materials for candidates; instead, everything is now
digital. However, even larger savings have accrued from the provision of job
advertisements free of charge to NHS employers.
Most Trusts now have no need to advertise any of their vacancies anywhere else. The
equivalent advertising spend needed to attract candidates without using NHS Jobs
would easily top £100m per year across the NHS (a recent study for teachers, for whom
there is no NHS Jobs equivalent, showed that average advertising spend was around
£800 per teacher per vacancy, even when using the limited digital routes). NHS Jobs is
responsible for filling around 200,000 vacancies each year; using the teacher
benchmark, this is £160 per annum.
NHS Jobs costs less than £2m per year to run.
As the very high levels of NHS takeup indicate, this unprecedented ‘next generation’
shared service has delivered greatly improved satisfaction levels amongst both NHS
employers and candidates across the UK, creating a much more efficient process
involving greater choice of roles in one location, and greater visibility of the status of
both job roles and applications at any stage of the process. Recruitment across Europe’s
largest employer has become simpler, faster, and (much, much) cheaper, with reduced
complaints and rapid resolution.
NHS Jobs has been recognised by the Cabinet Office as an example of Best Practice in
Government recruitment, and the service has won several industry awards.
NHS Jobs 2: the reprocurement
In 2012, following almost a decade of successful operation of NHS Jobs, the Department
of Health approached the market again; the original contract would expire after 10
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years. Over at Methods, Kit and Dave gathered eagerly around Dave’s computer monitor
as the procurement notice popped up on the screen. Obviously, both were expecting
that the Department, learning from the tremendous transformation that a digital
platform approach can bring, would seek to retender for a platform-based business
model for the next generation of the NHS Jobs service. Both felt pretty confident that, as
disruptive innovators the first time around, they would be ready for anything the
Department might throw at them this time. But as their eyes travelled over the
announcement, the colour drained from Kit’s face.
The advertisement began by praising the success of NHS Jobs, with a glowing
description of the sorts of startling statistics included earlier: so far, so good. However,
the Department had clearly been doing some thinking about the nature of successful
platforms: for remember, platform-based digital business models comprise both the
site/service itself, as well as the traffic on the service – the consolidation of all that
valuable market demand attracted by the ease of connection and use. The Department
had clearly realised that possession of the NHS Jobs site, with its millions of hits, had
become a highly valuable business opportunity for the right supplier – and had modified
its recruitment approach accordingly!
Kit and Dave finished reading the tender advertisement: six weeks remained to develop
an alternative business model, still based around the existing NHS Jobs platform service,
but which would offer more, and make money in a different way.
“Good job neither of us has any vacation planned!”, Dave muttered…
Class Questions
1. What do you think were some of the main characteristics of the Department of
Health’s tender advertisement, in terms of what they were looking for from
suppliers? How would they judge the winning tender?
2. How would you respond if you were Kit and Dave? How would your response be
priced?
3. Think of another industry area that you believe might be well placed to take
advantage of a disruptive entry by a digital platform business model.
a. Why is the industry ripe for ‘platform-isation’?
b. Which existing business models would suffer, and why?
c. How would your platform take on the incumbents?
d. What additional benefits would your service provide?
e. What makes these ‘digital’?
f. What revenue streams and pricing models would you seek?
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